According to this article, Anthem is withdrawing from most insurance markets in Ohio:

Based on current company footprints, this would appear to leave 20 rural Ohio counties at risk of lacking a single insurer on the Obamacare exchange, or market, in 2018, according to Sen. Rob Portman.

If no other insurer steps in, what happens to people living in those counties who relied on insurance purchased from the exchange? Will they still be required to pay a fine if they do not purchase private insurance?

  • There are places in Iowa that will have 0 options next year Commented Jun 7, 2017 at 16:53

3 Answers 3


There's currently no plan should a state or county have no Obamacare insurer.

This NYT article reports that:

If insurers do all decide to exit a market, no one is exactly sure what will happen next. Some experts have brainstormed about possible workarounds, but all would entail uncharted legal territory.

However, the article also mentions that it's unlikely that any place will have no insurers in the near future due to the way Obamacare works. Basically, if there's only one insurer, that insurer can name its price so –

“Why be at zero — why not come in and charge a freaking outrageous price and be the one?”

In theory, the bare market problem shouldn’t be a big worry. The federal government pays a large fraction of Obamacare premiums for most customers, and a single insurer can essentially name its price. Economists like Mr. Garthwaite see the situation as a happy circumstance for an insurance company. Who wouldn’t want a monopoly market where the government pays the bills?

To date, some places have come close to losing all its insurers but it still hasn't occurred before. So, it remains to be seen in the future.

As for the penalties for not having insurance, Trump has signed an executive order that weakens enforcement for all Americans to purchase insurance as one can submit their taxes without filling out the insurance question, thus making enforcement more difficult.

The I.R.S. recently notified tax preparers that it will not reject tax returns that omit information about whether a filer had health insurance during the previous year. That’s actually a continuation of an informal Obama administration policy, but because of the way the decision was announced, it is likely to have broader effects on how many people report their insurance status to the government and how many people end up paying penalties for staying uninsured.

Some articles worth checking out:

  • 1
    Wow that was quick! Thanks, I'll check these out. I also just found the guidelines for exemptions -- so I guess if you don't qualify for Medicaid, and you can't find private insurance for < 8.13% of your income, you can apply for an income-based exemption from the penalty. Otherwise... dunno! Of course that may change, and good point about the question being unenforced.
    – user812786
    Commented Jun 7, 2017 at 17:10
  • Panda, please be careful about your statement that the executive order weakens enforcement. The IRS can still impose a penalty if there is an audit. It is still the law. Commented Jun 7, 2017 at 22:26

I agree with others that no one really knows what will happen to the ACA enrollees when all carriers abandon a county. However it should be pointed out that the map of counties that are threatened is very fluid. One month ago many counties in MO were included in the list of those that could loose coverage in 2018, a month later that picture changed and now no counties are under threat. A second point I would hasten to make is this: Contrary to what some may believe, if there is only one carrier in a coverage area, the carrier is NOT "free to name their own price". As long as the ACA's provision of an 80% Medical Loss Ratio remains in effect, carriers must prove that at least 80% of the premiums they collect are paid out in actual benefits to subscribers. Failure to met that 80% threshold requires the carrier to rebate premiums to the subscribers. The House bill and the Senate drafts (at this time) would eliminate that provision.


Since BCA is the only provider in the state that I live (KY), and it is making noises like it might pull out at the end of 2017, I am facing the same issue.

And so far, the answer is - we don't know what will happen, other than we won't have an available health care plan.

This is not a trivial issue. As for the previous answer/NYT article suggesting 'charging what the market will bear', do you know what a BCA Obamacare plan for a family of four costs? For me, it's $1900/month, which is sucking up almost half my take home pay. And that's for the cheapest plan they had. If it goes any higher, I will have no choice but to drop it and pray no one in my family gets seriously ill. Before obamacare, I was contributing maybe $200/month to a company health care plan (which the contracting company ditched as soon as it could). Those were the good old days...

Oh, and while my state gives me a modest tax writeoff for that whopping expense, the feds who foisted this turkey off on us, don't give me one red cent back.

What is my solution? I am scrambing to ditch my contract software job, and get a full time job that comes with a company health care plan. However, not everyone can do that. Heaven help those who don't have the job skills I do, because the faltering obamacare sure won't help them.

Hmmm.... wasn't obamacare supposed to address the 'full time job or serious problem with health care' issue? Looks like we're right back where we started, only the price is a lot higher.

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    Sounds like your costs went up because your employer decided to stop providing a company plan, along with the usual practice of the company picking up most of the premium. Not sure why you are claiming that was somehow caused by the ACA. "Obamacare" basically set up a system where individual buyers could join a collective insurance risk pool for purchasing. It didn't do much of anything to the employer-offered marketplace. Commented Jun 7, 2017 at 21:25
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    @PoloHoleSet - There were definitely employers who said "You can get insurance on your own, I'm not going to cover it for you anymore." That said, this answer does not have anything useful to contribute to the question, and it's pretty much just a rant.
    – Bobson
    Commented Jul 23, 2017 at 17:19
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    When the ACA was enacted, the employer mandate was dropped for some situations - including software contracting companies. Those of us who work through those companies were forced onto ACA, with no choice. The cost for a family of four for me went from $200/month company supported, to $800/month ACA, then to $1000, then to $1400, and after the last increase, $2k month. You would know about this forced movement if you had actually read facts, instead of looking at political affiliation and deciding if something was good.
    – tj1000
    Commented Jul 23, 2017 at 18:08
  • @Bobson - yeah, but since the ACA pretty much covered the individual market, that's more an excuse than a cause. Employers have also been dumping costs to employees, either partially or completely for decades, as well. That's what the skyrocketing deductibles and co-pays are about, as well. Commented Jul 24, 2017 at 14:18
  • 1
    tj1000 - most of my career has been in health insurance, both private and government. I can guarantee you that your attribution of blame is completely based on ignorance. Your increased premium costs were 100% about your company pocketing your insurance premiums. They gave you a massive compensation cut, blamed it on the ACA, and you went along with it. Commented Jul 24, 2017 at 14:20

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